PSYA02H3: Chapter 13-14 (Mtuner 3 Review)

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Chapter 13.1: Defining and Classifying Psychological Disorders
• Medical model: using our understanding of medical conditions to think about psychological conditions
o E.g. someone who experiences hallucinations would likely be diagnosed with psychological
disorder in US, but might be possessed by evil spirits, victim of a curse in another time or place
• Biopsyosocial model:
• Abnormal psychology: psychological study of mental illness
o Person who cuts/ burns himself until he sustains serious injury is behaving abnormally
o Someone who obtains a medical degree before age of 20 is unusual (may or may not show
mental illnesses)
 Person who harms himself ­> maladaptive behavior: behavior that hinders a persons
ability to function in work, school, relationships, or society
 American Psychiatric Association (2000) ­> three criteria to identify maladaptive
behavior:
1) The behavior causes distress to self or others
2) The behavior impairs the ability to function in day­to­day activities
3) The behavior increases the risk of injury, death, legal problems or punishment for
breaking rules, or other detrimental consequences
• Diagnostic and Statistical Manual for Mental Disorders (fourth edition, Text Revision); DSM­IV: the
manual that establishes criteria for the diagnosis of mental disorders
o Created & updated by expert panels from APA
o Sets clear guidelines for determining the presences & severity of some 350 mental disorders
o For each disorder in DSM­IV, guidelines convey 3 important pieces about individuals
experience:
1) A set of symptoms
2) Etiology: or the origins or causes of symptoms
3) How these symptoms will persist/ change over time, with out without professional treatment
o DSM­IV addresses problems associated with the psychical, mental, and social functioning of an
individual
 Attests to how useful the biopsyosocial model is in understanding mental health
 Many insurance companies will not cover treatment for mental health problems without a
formal diagnosis
 Has limits ­> mental health professionals do not unanimously agree on how to classify
many disorders, and disputers often arise over whether some conditions should be
included or excluded from the manual
• Disorders covered in the DSM­IB are primarily based on observations of clients/
patients, rather than on potentially more objective markers of mental disorders
such as genes, neurotransmitters, or brain abnormalities­ practice that leaves room
for subjectivity & for individuals to potentially fake psychological problems ­>
psychologists believe that biological markers, some of which could be detected by
brain scans, should be identifies and incorporated into diagnostic criteria • DSM­IV ­> created new edition – the DSM­V­ in May 2013
o Reflect the substantial advances in neuroscience & genetics that have contributed to our
knowledge of psychological disorders
• Challenge when classifying mental disorders ­> either/ or distinction between normal &
abnormal does not reflect the complexity of human behavior
o Many symptoms of psychological disorders consist of typical thoughts and behaviors,
expect that they’re more severe & longer lasting than usual (may occur in inappropriate
contexts or without any clear reasons)  Viewing psychological disorder as an extreme case of otherwise normal behavior
reflects the dimensional view
• E.g. someone who has an unusually stressful experiences that brings about
heightened anxiety may feel fine after several days
• In contrast ­> when stress/ anxiety lasts a long period of time ­> can
change persons life ­> then the condition may become recognized as a
psychological disorder (PTSD) ­> veterans returning from active military
duty, or people who survive violence crimes, accidents/ traumatic events
o Individuals might show range of symptoms that are indicative of
PTSD depression
 Categorical view regards different mental conditions as separate types;
differences between normal & abnormal functioning are of kind, rather than
degree
• According to this approach, a disorder is not just an extreme version of
normal thoughts & behaviors ­> something altogether different
• E.g. Down syndrome
o Involves an unusual genetic condition: As individual either has the
extra 21 chromosome linked to Down syndrome or does not
o Not expect to find someone who as a ‘partial” form of the disorder
• The condition must be categorical is not a psychiatric criterion for mental illness
• Andrea Yates committed psychiatric hospital in Texas for murdering her 5 children
o Was not found guilty by reason of insanity ­> jury believed she could not distinguish
right from wrong at time of murders
• Jeffrey Dahmer murdered at least 15 men ­> attempted to turn his victims into zombies ­> poured
acid in holds & drilled into their skulls/ engaged in sexual & cannibalistic acts with corpses ­>
found to be same ­> his admission of guild & remorse suggested he understood what he did was
wrong
o Insanity defense: legal strategy of claiming that a defendant was unable to differentiate
between right & wrong when criminal act was committed
• Contemporary research is examining use of diagnostic labels from multiple perspectives
o How does diagnostic labels affect the individual’s self­perception?
 Group led by Jill Holm­Denoma ­> 53 volunteers participate rated their positive
& negative emotions at 5 times: before & after an intake session
• Stigma & stereotyping can have negative effects, leading to prejudice & misattribution of
behaviors
• Insanity means that an individual could not distinguish between right and wrong when he/she
broke the law
• Physiological symptoms of PYSD may be common along people of different cultures, but the
specific concerns people have can vary
• Labeling can either have positive/ negative effects, deepening on factors such as context &
cultural expectations
Chapter 13.2: Personality and Dissociative Disorders
• Personality disorders: particularly unusual patterns of behavior for one’s culture that are maladaptive,
distressing to oneself or others, and resistant to change
o Observed in people who tend to be quirky & difficult to get along with, do not present threat to
themselves or others
o Significant functional impairment or subjective distress
o Marked deviation from cultural expectations • Borderline personality disorder (BPD): characterized by intense extremes between positive & negative
emotions, an unstable sense of self, impulsivity and difficult social relationships
o Connected to a tendency to think in all­or­none terms
o E.g. Person with BDP may fall in love quickly, professing deep commitment and affection, but
just as quickly become disgusted by someone’s imperfections
 Prevents an individual from rationally understanding that, no matter how much a person
means to the individual, there are bounds to be periods in the relationship
o Can become paranoid, suspecting that everyone else has similarly unpredictable feelings
 Fear of abandonment is very intense ­> may drive them to go to extremes to prevent the
loss of a relationship ­> may lead to risky sexual behavior as individual desperately tried
to secure relationships
• Tendency toward self­injury (cutting or burning oneself)
• Narcissistic personality disorder (NPD): characterized by an inflated sense of self­importance and an
intense need for attention and admiration, as well as intense self­doubt and fear of abandonment
o Little room for empathy
o Known to manipulate & arrange their relationships to make sure their own needs are met, no
matter the toll it takes on others
o E.g. Students with narcissistic tendencies are morel likely to engage in academic dishonestly
than others ­> their sense of entitlement and specialness allows them to cheat without feeling any
guilty/ remorse
• Histrionic personality disorder (HPD): characterized by excessive attention seeking & dramatic behavior
o “Histrionic” comes from Latin word meaning “like an actor or like a theatrical performance” –
and apt label for this disorder
o Typically successful at drawing people in with flirtatiousness, provocative sexuality and flattery
 Extreme shallowness & emotional immaturity
• People with APD ­> psychically & verbally abusive, destructive, & frequently find themselves in trouble
with the law
• Men are 3 times more likely to be diagnosed with APD than women o Symptoms of patterns of harming & torturing people or animals, destroying property, stealing,
and being deceitful
• Similar pattern was found when psychologists compared people with psychopathy who had been
convicted of violent crimes with non­psychopathy controls in a procedure involving aversive classical
conditioning
o People with psychopathy and control participants looked at brief presentations of photographs of
human faces (the conditioned stimulus) followed by a brief but painful application of pressure to
the body (the unconditioned stimulus)
The Biopsyosocial approach to Personality Disorders
1) Psychological factors
a. Persistent beliefs about the self are a major part of human personality
b. Person with narcissistic personality seeks to avoid negative attention at all costs because it brings
unpleasant hostile/ depressive reactions
i. To ward off the feelings, the person continues to seek attention
c. Adults with psychopathy & children with conduct disorders (often a precursor to psychopathy
(have difficulty learning tasks that require decision making and following of complex rules
i. Brain imaging studies ­> children with conduct disorders perform worse at these tasks &
have reduced activity in the frontal lobes compared with attention0deficit/ hyperactivity
disorder (ADHD)
ii. Appears that cognitive factors & underlying brain processes can help explain personality
disorders
2) Sociocultural factors
a. Children begin to develop social skills & emotional attachments at home & in local
neighborhood
b. Troubled homes & neighborhoods ­> development of psychopathy & antisocial personality
disorder: Condition marked by a habitual pattern of willingly violating other’s personal rights,
with very little sign of empathy or remorse
i. History with physical, sexual, & emotional abuse have been treated as objects rather than
as sensitive human beings ­> might not empathize with others, including animals
c. Less severe cases of conditions such as BPD may arise from profound invalidation during
childhood ­> when child’s caregivers did not respond to his/her emotions as if they were real &
control emotions, so they tend to react more strongly to everyday life stressors
3) Biological factors
a. Number of specific genes seem to contribute to emotional instability through serotonin systems
in brain
b. Research appoints to unique brain activity in the limbic system and frontal lobes­ brain regions
that are associated with emotional responses & impulse control, respectively
• Comorbidity: presence of two disorders simultaneously, or the presence of a second disorder that affects
the one being treated
o E.g. person who is being treated for heart disease may also have diabetes & presence of both
diseases in same individual can complicate treatment
 Substance abuse is often comorbid with personality disorders
• Enjoyment of pain is the least likely to be related to personality disorders in biopsyosocial factors
• Dissociative disorder: a category of mental disorders characterized by a split between conscious
awareness from feeling, cognition, memory, and identity
o Dissociative fugue: A period of profound autobiographical memory loss
 May go as fat as to develop a new identity in new location with no recollection of their
past
o Depersonalization disorder: A belief that one has changed in some fundamental way, possibly
ceasing to be “real” o Dissociative amnesia: A severe loss of memory, usually for a specific stressful event, when no
biological cause for amnesia is present
• Dissociative identity disorder (DID; sometimes referred to as multiple personality disorder): person
claims that his/ her identity has split into one or more distinct alter personalities, or alters
o Alters may differ in name, gender, sexual orientation, personality, behavior, memory, perception
and autobiographical sense of self
o Can be so strong that one alter may have no memory of events experiences by other alters
o DID ­> extreme stress event, or series of events that precipitated the onset of the condition
 Elements of violence & intentional humiliation, such as rape, insertion of objects into
body, or forms of sexual torture
o Although DID appears in melodramatic & comedic films on regular basis ­> very rare disorder
 Only 1% have been diagnosed with DID
 Very difficult to test for (don’t provide solid evidence for a biological basis of DID)
• One approach ­> check for memory dissociations between alter identities (one
study, patients viewed words & pictures & tested for recall of the stimuli either
when they were experiencing the same alter as when they learned or when they
were experiencing a diff alter ­> results suggest that some types of learning do not
transfer between alter identities ­> finding suggest the two alters are truly separate
identities)
• Another approach ­> record patterns of brain activity
o Using positron emission tomography (PET) ­> found differing frontal lobe
activity for people with DID while they were experiencing each of their
alters
 Skeptics have argued against the validity of DID in a number of diff cases because
skeptics have cited all of these arguments
Chapter 13.3: Anxiety and Mood Disorders
• Anxiety disorders: category of disorders involving fear/ nervousness that is excessive, irrational and
maladaptive
o Frequently most diagnosed disorder
• Everyone experiences feelings of anxiety ­> flight­or­flight response (racing, pounding heart with
increased respiration ­> allows for quick energy use)
• Primary symptoms of all anxiety disorders include basic feelings of anxiety (unjustifiable degree,
duration, and source of anxiety)
• Generalized anxiety disorder (GAD): involves frequently elevated levels of anxiety that are not directed
at or limited to any particular situation­ the anxiety is generalized to just about anything
o People with GAD often feel irritable and have difficulty sleeping and concentrating
o What makes GAD distinct from other anxiety disorders ­> people who have it often struggle to
identify the specific reasons for why they are anxious
 Doesn’t seem to go away, even if a particular problem/ issues is resolved
 Anxiety becomes redirected toward some other concern
 Onset of GAD can be attributed to a variety of factors, not all of which are clear, but
major life changes commonly precede its onset
• Panic disorder: anxiety disorder marked by repeated episodes of sudden, very intense fear
o Anxiety occurs in short segments, but can be much more severe
o Key feature ­> panic attacks­ brief moments of extreme anxiety that include rush of physical
activity paired with frightening thoughts
o Escalated when fear of death causes increased physical arousal, and increased physical
symptoms feed frightening thoughts  Goes on for more than 10 mins, after which individual will eventually return to more
relaxed state
o Often develop an intense fear that panic will strike again ­> lead to ­> agoraphobia: an intense
fear of having a panic attack or lower­ level panic symptoms in public ­> individual may begin to
avoid public settings so as to avoid embarrassment & trauma od a panic attack
 In extreme forms, agoraphobia leads an individual to stay inside his/her home almost
permanently
• Phobia: severe, irrational fear of a very specific object or situation
• Best known form of phobia ­> specific phobias: involve an intense fear of an object, activity or
organism
o Specific animals, heights, thunder, blood, and injects or other medical procedures
• Social anxiety disorder: irrational fear of being observed, evaluated or embarrassed in public
o E.g. person can go out in public but prefers familiar places & routines
o Will avoid many other situations because the anxiety levels are too high
• Obsessive­compulsive disorder (OCD): disorder characterized by unwanted, inappropriate, and
persistent thoughts (obsessions) repetitive stereotyped behaviors (compulsions); or a combo of the two
• Compulsive behaviors often arise from specific obsessions
o E.gg someone who is obsessively worried about starting a fire might develop compulsive
checking all lamps & appliances are unplugged before leaving house
• Most difficult aspects of anxiety ­> tend to be self­perpetuating
• Vicious cycle appears in other anxiety disorders
o E.g. young girl who tried to pet a neighbors cat, but the cat starches her
o The incident didn’t leave a lasting physical scar, but years later the girl still feels nervous around
cats & reluctant to even enter a house if owners have a cat
 Cat triggers an anxiety response • Depression isn’t classified as an anxiety disorder
• Obsessions are repetitive, unwanted thoughts whereas compulsions are repetitive behaviors
• Allison has intense fear of flying, so that she cannot even bear to close her eyes & imagine that she is on
a plane ­> specific phobia
• The emotions associated with anxiety lead to psychological responses, which in turn lead to more
anxious emotions, creating a vicious cycle
• If anxiety leads to the onset of so many diff disorders, how can this be beneficial, adaptive process?
o The physiological response underlying anxiety prepares us to fight or flee
• Major depression: disorder marked by prolonged periods of sadness, feelings of worthlessness and
hopelessness, social withdrawal, and cognitive and physical sluggishness
o Depression involves more than just feeling sad for a long period of time­ cognition becomes
depressed as well
 Affecting concentrating & making decisions while memories shift toward unpleasant and
unhappy events
 May become lethargic & sleepy, yet experience insomnia
 People who are feeling sad do not necessarily experience all of these cognitive &
biological symptoms, so major depression is clearly a distinct psychological disorder
• Bipolar disorder (formally referred to as manic depression): characterized by extreme highs and lows in
mood, motivation and energy
o Shares many symptoms with major depression­ some distinguish the two by referring to major
depression as unipolar­ but it occurs only a third as often as depression
o Involves depression at one end & mania (an extremely energized, positive mood) at the other end
o Mania may take several forms: some individuals talk so fast that their thoughts cant keep up;
others run up credit cards, of thousands of dollars with the idea that somehow they can afford it  Individual often doesn’t feel distress about the mania until it has passed, at which time
they feel a great deal of remorse & embarrassment
• Depression affects cognition as well as emotion
o People with depression become confused & have difficulty concentrating and making decisions
o Depressive explanatory style emerges ­> depressed individual explains life with three qualities
1) Internal
2) Stable
3) Global
• Twin studies suggesting an underlying genetic risk for developing major depression
o Brain imaging research has identified two primary regions of interest related to depression
1) The limbic system ­> active in emotional responses & processing
2) Dorsal (back) of the frontal cortex ­> plays a role in controlling thoughts & concentrating
• The overactive limbic system responds strongly to emotions & sends signals that lead to decrease in
frontal lobe activity ­> decrease in frontal lobe functioning reduces ability to concentrate & control what
one thinks about
• Various neurotransmitters of the brain­ especially serotonin, dopamine, and norepinephrine­ appear to
increase risk of depression
• Biological & cognitive factors of depression interact with environmental influences
o Socioeconomic & environmental factors leave some individuals more vulnerable to mood
disorders
o People who inherit “short” copies of a gene responsible for serotonin (5­HTT) activity are
predisposed to depressive episodes in response to stress, whereas those who inherit “long” copies
are less prone to depression (“short” and “long” refer to the structure of the different versions of
the genes) ­> more prone to suicide attempts
• Suicide is 4 times more likely among males than females
o More likely among native Americans & European Americans
• First­time callers to suicide prevention lines benefit most from empathy and active listening Chapter 13.4: Schizophrenia
• Schizophrenia: refers to a collection of disorders characterized by chronic and significant breaks from
reality, a lack of integration of thoughts & emotions, and serious problems with attention and memory
o Hallucinations: false perceptions of reality such as hearing internal voices
o Delusions: false beliefs about reality
 E.g. person with schizophrenia may experience a delusion of grandeur ­> believing that
he is Jesus
• Paranoid schizophrenia: Symptoms include delusional beliefs that one is being followed, watched, or
prosecuted and may also include delusions of grandeur
• Disorganized schizophrenia: Symptoms include thoughts, speech, behavior, and emotion that are poorly
integrated and incoherent ­> may also show inappropriate, unpredictable mannerisms
• Catatonic schizophrenia: Symptoms include episodes in which a person remains mute * immobile­
sometimes in bizarre positions­ for extended periods ­> may also exhibit repetitive, purposeless
movements
o A patient who is nonresponsive & remains still in off postures
• Undifferentiated schizophrenia: Includes individuals who show a combo of symptoms from more than
one type of schizophrenia
• Residual schizophrenia: Reflects individuals who show more symptoms of schizophrenia but are either
in transition to a full­blown episode or in remission
• Positive symptoms: refer of behaviors that should not occur, such as confused and paranoid thinking,
and inappropriate and emotional reactions
o A person with schizophrenia who experiences delusions that she is royalty is experiencing
positive symptom
• Generally, people with schizophrenia are no more likely to become violent than non­mentally ill people,
and if violence occurs, other factors, such as substance abuse, are likely to contribute to its cause
• There have been several famous cases of people with superior intellectual abilities as well as
schizophrenia. Does this mean that schizophrenia is the cause or the result of genius?
o No; in fact the avg IQ of peopl